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2016
Nigerian Educators' Attention-Deficit
Hyperactivity Disorder Knowledge and Classroom
Behavior Management Practices
Arthur N. Ojionuka Walden University
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Walden University
College of Social and Behavioral Sciences
This is to certify that the doctoral dissertation by
Arthur Ojionuka
has been found to be complete and satisfactory in all respects, and that any and all revisions required by
the review committee have been made. Review Committee
Dr. Cheryl Tyler-Balkcom, Committee Chairperson, Psychology Faculty Dr. John Deaton, Committee Member, Psychology Faculty Dr. Jonathan Cabiria, University Reviewer, Psychology Faculty
Chief Academic Officer Eric Riedel, Ph.D.
Walden University 2016
Abstract
Nigerian Educators’ Attention Deficit Hyperactivity Disorder Knowledge and Classroom Behavior Management Practices
by
Arthur N. Ojionuka
MS, Psychology, Walden University, 2013 BS, Psychology, Walden University, 2012 ThD, Kingsway Theological Seminary, 1992
Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Philosophy Clinical Psychology
Walden University April 2016
Abstract
This correlational study assessed Nigerian educators’ knowledge about attention deficit/hyperactivity disorder (ADHD) and inclusive classroom management practices when serving students with ADHD. Specifically, the study examined the predictive correlation between teachers’ demographic characteristics, including years of teaching experience, level of education, and knowledge about ADHD, as well as how their knowledge informed their choice of behavior management interventions. Teachers are accountable for pedagogical responsibilities including maintenance and management of a learning environment that promotes learning and inclusion. Further, they play a significant role in identifying and supporting students with learning impairments including ADHD. Thus, it is critical for teachers to have unambiguous knowledge about ADHD and evidence-based behavior management practices. One thousand teachers participated. The Knowledge of Attention Deficit Disorder Scale (KADDS) and the Teachers’ Interventions for ADHD Students (TIAS) survey instruments were used for data collection. Descriptive statistics, multiple linear regression, and multinomial logistic regression were employed to analyze the data. Results indicated that teachers demonstrated high levels of misconception and limited knowledge regarding ADHD. Teachers’ levels of education and years of teaching experience did not match or improve their cumulative knowledge of ADHD. Knowledge about ADHD predicted teachers’ choice of behavior modification strategies for the characteristic behaviors of ADHD. Teachers implemented negative disciplinary consequences (consequence-based strategies) and multiple interventions for shaping specific negative behaviors associated with ADHD, indicating a lack of competence in classroom management practices. This study offers invaluable information on the status of Nigerian teachers’ ADHD knowledge and classroom management practices and may inform decisions for the development and implementation of differentiated instruction strategies, teacher training, and academic curriculum to improve teachers’ pedagogical competence and students’ academic outcomes.
Nigerian Educators’ Attention Deficit Hyperactivity Disorder Knowledge and Classroom Behavior Management Practices
by
Arthur N. Ojionuka
MS, Psychology, Walden University, 2013 BS, Psychology, Walden University, 2012 ThD, Kingsway Theological Seminary, 1992
Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Philosophy Clinical Psychology
Walden University April 2016
Dedication
I dedicate this dissertation to my entire family for their invariable and
unconditional love and support, and for their belief in me and in my dreams. I recognize their individual and collective sacrifices toward my achievement of this goal. I want to particularly show appreciation to my wife, Gina Ojionuka, for her constant
encouragement even when things looked bleak. Baby, I did this for you, and I am indebted to you. I love and thank you.
Acknowledgments
Barring my personal efforts, Divine Authority and many individuals contributed significant efforts in the completion of this dissertation. Preeminently, I could not have accomplished anything without the indefectible help of my Lord and Savior Jesus Christ, whose unfailing grace and inimitable inspiration guided my steps through this process.
I acknowledge and extend my gratitude to my friend—Owelle Rochas Okorocha, the Governor of Imo State, Nigeria, for granting an express permission for this research in the State. Thank you! As well, I acknowledge the teachers who committed their time and efforts to participate in this study by completing and returning the surveys. Thank you for your help, demonstrable support, and enthusiasm.
I remain highly indebted to Dr. Cheryl Tyler-Balkcom, my dissertation chair. I am grateful for her encouragement and commitment, as well as for believing in and insisting on the best of me throughout the process. I personally acknowledge the efforts and contribution of my committee and URR members, Dr. John Deaton and Dr. Jonathan Cabiria. They raised important questions, challenged my thoughts, and provided me with invaluable input.
Finally, my deepest love and appreciation go to my children, and most
importantly to my wife, Gina, for her extraordinary sacrifices and unparalleled devotion to hold down the fort as I persevered through this long and rewarding research project. Her courage and commitment to stride both our organization and family management responsibilities were the driving force behind the success of this dissertation.
i
Table of Contents
List of Tables ... vii
List of Figures ... ix
Chapter 1: Introduction to the Study ...1
Introduction ...1
Background of the Study ...2
Problem Statement ...7
Purpose of the Study ...9
Research Questions and Hypotheses ...10
Research Question 1 ... 10
Research Question 2 ... 10
Research Question 3 ... 10
Research Question 4 ... 11
Theoretical Framework ...12
Theory of Cultural Relativism ... 12
Nature of the Study ...15
Quantitative (Nonexperimental, Cross-Sectional, and Survey Design) ... 15
Instrumentation ...15
Definition of Terms...17
Assumptions ...18
Scope and Delimitations ...18
ii
Significance of the Study ...19
Summary ...20
Chapter 2: Literature Review ...22
Introduction ...22
Literature Search Strategy...23
Emergence of Inclusive Education ...24
Attention Deficit/Hyperactivity Disorder (ADHD) ...26
ADHD: Etiology and Prevalence ... 27
ADHD Prevalence in Nigeria ... 29
ADHD: Subtypes and Diagnostic Criteria ... 31
ADHD and Pedagogical Environment ... 32
Educators’ Misperceptions of ADHD Behaviors ... 38
Teachers’ Knowledge About ADHD ...39
Knowledge About ADHD, Prior Training, and Experience ... 39
Classroom-Behavior Management Strategy Decisions ... 43
Inclusive Education ...45
Inclusive Education in Nigeria... 47
Perceptions of Inclusive Education and Students in Nigeria ... 49
Influences of Cultural Beliefs ... 51
Organization of Inclusive Education Classes in Nigeria ... 53
ADHD Knowledge and In-Service Training ...55
iii
Inclusive Classroom and In-Service Training... 61
Classroom Behavioral Interventions ...63
Teachers’ Training and Classroom Management Strategies ... 65
School-Based Classroom Intervention Strategies ... 67
Antecedent-Based Strategies ... 69
Consequent-Based Strategies ... 70
Academic-Based Strategies ... 73
Self-Regulation Intervention ... 74
Theoretical Framework ...75
Theory of Cultural Relativism ... 75
Conclusion ...78
Chapter 3: Research Method ...80
Introduction ...80
Research Design and Rationale ...80
Research Questions and Hypotheses ...82
Research Question 1 ... 82 Research Question 2 ... 82 Research Question 3 ... 84 Research Question 4 ... 86 Research Methodology ...88 Research Population... 89
iv
Sample Size ... 90
Data Collection ... 91
Data Analysis ... 91
Preanalysis Data Screening ... 92
Instrumentation ...92
Validity and Reliability ... 93
Teacher Intervention for ADHD Students (TIAS) ... 94
The Knowledge About Attention-Deficit Disorder Scales (KADDS) ... 96
Operationalization of Variables ... 100
Antecedent, Consequent, and Academic Strategies ... 101
Ethical Considerations ...101
Informed Consent... 102
Data Storage, Retention, and Destruction to Protect Confidentiality ... 103
Threats to External Validity ... 103
Threats to Internal Validity ... 103
Conclusion ...104
Chapter 4: Results ...105
Introduction ...105
Preanalysis Data Screen ...105
Descriptive Statistics ...106
Frequencies and Percentages of Demographics ... 106
v
Research Question 2 ... 112
Years of Teaching Experience and General Awareness ... 113
Years of Teaching Experience and Etiology ... 116
Years of Teaching Experience and Intervention ... 118
Years of Teaching Experience and Overall Knowledge ... 120
Research Question 3 ... 123
Level of Education and General Awareness ... 124
Level of Education and Etiology ... 126
Level of Education and Intervention ... 128
Level of Education and Overall Knowledge ... 130
Research Question 4 ... 133
Inattentiveness Vignette ... 135
Wandering Vignette ... 136
Poor Peer Interaction Vignette ... 137
Speaking Out of Turn Vignette ... 138
Summary ...138
Chapter 5: Discussion, Conclusions, and Recommendations ...140
Summary of the Study ...140
Ethical Dimensions ...143
Overview of the Study Population and Sampling Method ...143
Data Collection Processes ...144
vi
Limitations ...145
Discussion of the Findings ...146
Research Question 1 ... 146
Research Question 2 ... 148
Research Question 3 ... 151
Research Question 4 ... 153
Recommendation for Further Action ...156
Recommendations for Future Study ...157
Implications for Social Change ...158
Final Summary ...161
References ...162
Appendix A: Inform Consent/Confidentiality Form...199
Appendix B: KADDS ...201
vii List of Tables
Table 1. Frequencies and Percentages of Sample Demographics ... 106 Table 2. Frequencies and Percentages of Raw Responses on the KADDS ... 107 Table 3. Descriptive Statistics of Continuous Variables (KADDS) ... 111 Table 4. Results of Multiple Linear Regression Between Years of Teaching Experience
and General Knowledge of ADHD ... 115 Table 5. Results of Multiple Linear Regression Between Years of Teaching Experience
and Etiology ... 118 Table 6. Results of Multiple Linear Regression Between Years of Teaching Experience
and Intervention ... 120 Table 7. Results of Multiple Linear Regression Between Years of Teaching Experience
and Overall Knowledge ... 123 Table 8. Results of Multiple Linear Regression Between Level of Education and General
Knowledge of ADHD ... 126 Table 9. Results of Multiple Linear Regression Between Level of Education and
Etiology ... 128 Table 10. Results of Multiple Linear Regression Between Level of Education and
Intervention ... 130 Table 11. Results of Multiple Linear Regression Between Level of Education and Overall
Knowledge ... 132 Table 12. Frequencies and Percentages of Classroom Behavior Intervention by
viii
Table 13. Multinomial Logistic Regression for Overall Knowledge and Classroom Behavior Intervention (Inattentiveness Vignette) ... 136 Table 14. Multinomial Logistic Regression for Overall Knowledge and Classroom
Behavior Intervention (Wandering Vignette) ... 137 Table 15. Multinomial Logistic Regression for Overall Knowledge and Classroom
Behavior Intervention (Poor Peer Interaction Vignette) ... 137 Table 16. Multinomial Logistic Regression for Overall Knowledge and Classroom
ix List of Figures
Figure 1. Bar chart for frequencies of overall knowledge scores as measured by the KADDS. ... 111 Figure 2. Bar chart for frequencies of general knowledge scores as measured by the
KADDS. ... 111 Figure 3. Bar chart for frequencies of etiology scores as measured by the KADDS. ... 112 Figure 4. Bar chart for frequencies of intervention scores as measured by the KADDS.
... 112 Figure 5. Normal P-P plot for general awareness subscale residuals. ... 114 Figure 6. Scatterplot to interpret homoscedasticity assumption between years of teaching experience and general awareness. ... 114 Figure 7. Normal P-P plot for etiology subscale residuals. ... 116 Figure 8. Scatterplot to interpret homoscedasticity assumption between years of teaching experience and etiology. ... 117 Figure 9. Normal P-P plot for intervention subscale residuals. ... 119 Figure 10. Scatterplot to interpret homoscedasticity assumption between years of
teaching experience and intervention. ... 119 Figure 11. Normal P-P plot for overall knowledge residuals. ... 121 Figure 12. Scatterplot to interpret homoscedasticity assumption between years of
teaching experience and overall knowledge. ... 122 Figure 13. Normal P-P plot for general awareness subscale residuals. ... 124
x
Figure 14. Scatterplot to interpret homoscedasticity assumption between level of
education and general awareness. ... 125 Figure 15. Normal P-P plot for etiology subscale residuals. ... 127 Figure 16. Scatterplot to interpret homoscedasticity assumption between level of
education and etiology. ... 127 Figure 17. Normal P-P plot for intervention subscale residuals. ... 129 Figure 18. Scatterplot to interpret homoscedasticity assumption between level of
education and intervention. ... 129 Figure 19. Normal P-P plot for overall knowledge residuals. ... 131 Figure 20. Scatterplot to interpret homoscedasticity assumption between level of
Chapter 1: Introduction to the Study Introduction
In 2008, Nigeria introduced the National Policy on Education, which embraces inclusive education in all classrooms for all students, including those with disabilities, regardless of the severity of their disabilities (Ajuwon, 2008). ADHD is prevalent among elementary and secondary school students in Nigeria (Adewuya & Famuyiwa, 2007; Bakare, 2012; Bakare, Ubochi, & Ebigbo, 2010; Ofovwe, Ofovwe, & Meyer, 2006). Consequently, in-class management of children presenting ADHD-characteristic behaviors has become an added responsibility for teachers.
ADHD is among the most common neurodevelopmental disabilities exhibited by children in the general education environment (Adewuya & Famuyiwa, 2007; Getahun et al., 2013). Barkley (2015) noted that an average of two students who exhibit symptomatic characteristics of ADHD, including inattention, hyperactivity, and impulsivity, or a combination of the three, are located in every classroom (American Psychiatric Association [APA], 2013). Teachers are responsible for maintaining learning environments that are responsive to the needs of all students; additionally, they play extraordinary roles in the referral of students for ADHD assessment (Alegría et al., 2012; Lee, 2014; Moldavsky, Groenewald, Owen, & Sayal, 2013; Ohan, Cormier, Hepp, Visser, & Strain, 2008; Vieira, Gadelha, Moriyama, Bressan, & Bordin, 2014).
Researchers have found an 8.7% prevalence rate of ADHD among the elementary and high school student population in Nigeria (Adewuya & Famuyiwa, 2007; Bakare, 2012; Bakare et al., 2010; Ofovwe et al., 2006; Ndukuba, Odinka, Muomah, Obindo, & Omigbodun, 2014). The implementation of inclusive education policy in Nigeria has
resulted in additional challenges in the classroom, and teachers lack knowledge and competence or skills to address them (Adeosun, Ogun, Fatiregun, & Adeyemo, 2013; Ajuwon, 2008; Emmer & Stough, 2001; Wu, 2015). Studies indicate that most of the general educators in Nigeria hold negative perceptions and attitudes about ADHD and lack information about characteristic behaviors of students with ADHD (Abiodun et al., 2011; Adeosun et al., 2013; Bakare, 2012; Bella, Omigbodun, & Atilola, 2011). In order to enhance teachers’ classroom management skills and assessment reports for students with ADHD as well as promote the students’ positive academic outcomes and social development, teachers need to have better knowledge of ADHD and effective behavior management strategies for students with ADHD.
Chapter 1 contains background details about the consequences of educators’ attitudes about ADHD and associated in-class behavioral modification interventions, in the context of social concerns and theoretical scholarly models. The problem statement highlights the need for this study and for assessment of Nigerian teachers’ knowledge and attitudes as well as the nature of their behavior modification approach in response to the inherently negative and characteristic behaviors that students with ADHD may present in the classroom. Other topics contained in Chapter 1 include (a) the purpose and
significance of the study, with details on the importance of the current study to the education field; (b) definitions of terms; and (c) the study assumptions, limitations, and delimitations.
Background of the Study
The Nigerian educational system has undergone various changes, including the introduction of the Universal Basic Education (UBE) scheme and the revision of the
National Policy on Education in 2008, in the pursuit of a set of educational policies that may cater to the learning needs of all Nigerian citizens (Ajuwon, 2008; Aluede, 2006; Okugbe, 2009; Oluwadare & Julius, 2011; Tsafe, 2013; UBE, 2006). The UBE scheme, which focused on Education for All (EFA) programs and the 2008 revised National Policy on Education, Section 7—Inclusive Education Policy, established a mandate that students with disabilities, including those with ADHD, regardless of severity, be
integrated into the general education environment with their nondisabled peers (Ajuwon, 2008; Aluede, 2006; Bryant, Smith, & Bryant, 2008; Frankel et al., 2010; National Policy on Education, 2008; Okugbe, 2009; Spiker, Hebbeler, & Barton, 2011). The
implementation of these policy changes occurred to ensure that all children with disabilities, including children who exhibit typical ADHD behaviors, receive free and appropriate public education in the least restrictive environment.
Researchers have reported that the characteristic presentation of ADHD students’ inattention, hyperactivity, and impulsivity were in direct conflict with required classroom behavioral conduct, including on-task and self-regulatory behaviors, information
processing and motivational demand (Imeraj et al., 2013; Wei, Yu, & Shaver, 2014). Studies have indicated that during class group teaching, ADHD children exhibited significantly less on-task behaviors, shorter on-task attention spans during academic tasks, and challenges with instructional transitions between tasks (Imeraj et al., 2013). Numerous studies have correlated ADHD behaviors with impaired social development as well as poor academic performance and achievement (Daley & Birchwood, 2010;
Wakefield, 2009) in elementary and middle school (Langberg et al., 2011), high school (Kent et al., 2011), college, and finally into the career years (Kuriyan et al., 2013).
Teachers spend considerable time attempting to control disruptive behaviors in classrooms at the expense of academic instruction (Bettini, Kimerling, Park, & Murphy, 2015; Emmer & Stough, 2001). Lack of competence in classroom management strategies and effective approaches for addressing disruptive student behaviors presents teachers with extraordinary challenges in meeting the pedagogical demands of the classroom (Emmer et al., 2001; Wu, 2015), because they must concomitantly mediate academic deficits while effecting behavioral interventions all of which require pedagogical expertise in dual content areas, including academic interventions and evidence-based classroom management practices (Brownell et al., 2012; Conroy, Alter, Boyd, & Bettini, 2014). Thus, classroom behavior management is fundamental to the success of the inclusive classroom, especially in addressing the unique behavioral needs of ADHD students (DuPaul et al., 2006; Fabiano et al., 2010). Classroom management consists of all actions teachers take to promote order and effective use of time during class activities, including managing behaviors; maintaining a consistent, structured pedagogical
environment; and applying differentiated instruction and strategies to a diversity of students (Dixon, Yssel, McConnell, & Hardin, 2014; Fabiano & Pelham, 2003;
Freedman, 2015; Watts-Taffe et al., 2012). Many teachers receive insufficient training on classroom management strategies, have no significant experience in educating ADHD students, and lack effective intervention skills for shaping negative behaviors (Van Tartwijk & Hammerness, 2011; Westling, 2010). Research indicates that very few teachers who teach at general education levels implement these behavior modifications
(Coles, Owens, Serrano, Slavec, & Evans, 2015; Romi, Lewis, & Roache, 2013). Despite the availability of these school-based behavior intervention strategies, research suggests that most Nigerian general educators either do not have accurate knowledge regarding the interventions or have not received adequate training to implement them (Van Tartwijk et al., 2011)
Culture can play a role in teachers’ perspectives on ADHD and impact what teachers know and how they perceive, interpret, and manage the behaviors of students with ADHD (Brown, Lake, & Matters, 2011; David, Richard, Dennis, & Stewart, 2014; Lee, 2014; Perold, 2010). Studies such as that of Rubie-Davies et al. (2012) have
established teacher beliefs as the product of the cultural context from which they emerge. In that sense, teachers’ professional responsibilities are both framed by and subservient to jurisdictional policies, educational models, and policy dogma pertaining to curriculum, pedagogy, and assessment (Brown et al., 2011). Therefore, it is plausible that teacher education experiences implicitly reflect this epistemology. For example, importantly, Rideout and Morton (2010) found that workshop socialization experiences share stronger correlative significance in predicting preservice teachers’ beliefs regarding classroom regulation and management than other personal variables.
In South Africa, a qualitative study of teachers indicated that students with ADHD were regarded as disrespectful or challenging (Lopes, Eloff, Howie, & Maree, 2009). Adeosun et al. (2013) suggested that Nigerian teachers’ knowledge and misconceptions about ADHD, instructional practices, and classroom behavioral
management strategies are confounded by cultural differences and beliefs about typical characteristic behaviors of ADHD (Ajuwon, Ogbonna, & Umolu, 2014). Even
experienced teachers seem to lack knowledge and training about ADHD (Sciutto, Terjesen, & Frank, 2000).
Researchers in the United States found a correlation between teachers’
instructional and classroom management strategies, knowledge about ADHD, and overall academic and social outcomes for ADHD students (Sherman, Rasmussen, & Baydala, 2008). Teachers are responsible for providing a responsive environment unique to the needs of individual students, including ADHD students, in the inclusive classroom (Kunter et al., 2013; Reyes, Brackett, Rivers, White, & Salovey, 2012). Teachers’ greater insight into knowledge about ADHD and possession of appropriate skills needed for classroom management interventions are important to overall general education. It is likely that such knowledge and skill can enhance Nigerian educators’ self-efficacy, confidence, and comfort in implementing differentiated instruction and effective pedagogic approaches to their ADHD students’ unique learning needs (Dixon, Yssel, McConnell, & Hardin, 2014). Many teachers are unsure of their ability to control and modify behavior problems associated with ADHD that disrupt learning environments and pedagogical responsibilities (Vieira, Gadelha, Moriyama, Bressan, & Bordin, 2014). Teachers have also reported a lack of training regarding ADHD and behavior intervention strategies as the underpinning obstruction to their effectiveness in managing
characteristic behaviors of ADHD (Koutrouba, 2013; West et al., 2005). Therefore, understanding Nigerian educators’ level of knowledge about ADHD, attitudes toward the disorder, and use of in-classroom interventions for characteristic behaviors of ADHD can be fundamental for successful pedagogy, inclusive practices, and positive outcomes for Nigerian students.
Problem Statement
According to Frankel, Gold, and Ajodhia-Andrews (2010), inadequate planning for the implementation of inclusive education in Nigeria resulted in a lack of
understanding of sociocultural and economic variables and assessment of teachers’ pedagogical skills, knowledge, and readiness. When teachers lack adequate knowledge about ADHD (Guerra & Brown, 2012; Koutrouba, 2013; Ohan, Visser, Strain, & Allen, 2011; Rodrigo, Perera, Eranga, Williams, & Kuruppuarachchi, 2011; Sciutto, Terjesen, & Frank, 2000), they are prone to misconceptions and negative perceptions about their ADHD students (Sciutto et al., 2000). These misconceptions could lead to teachers’ use of negative and disciplinary consequences as well as referrals (Bryan, Day-Vines, Griffin, & Moore-Thomas, 2012; Ergün, 2014; Ohan, Cormier, Hepp, Visser, & Strain, 2008; Tillery, Varjas, Meyers, & Collins, 2010; Westling, 2010). These consequences lead to increased frequency and intensity of maladaptive behaviors (Kaufman & Brigham, 2009), student resistance, and disengagement, as well as truancy and impaired chronic
externalizing of behaviors (Romi, Lewis, Roache, & Riley, 2011; Sullivan et al., 2014). A review of the existing literature indicates that Nigerian educators hold negative attitudes and misperceptions about negative behavioral characteristics of ADHD
(Adewuya & Famuyiwa, 2007). Additionally, some studies conducted in countries other than Nigeria have shown that most teacher training curricula do not include information about ADHD (Van Tartwijk et al., 2011), and that when ADHD information is included in preservice special education programs, Children with ADHD are disproportionately overpathologized as inherently dysfunctional and destitute of constructive characteristics (Freedman, 2016). As such, most teachers rely on actual classroom teaching experiences
involving students who have confirmed diagnoses of ADHD to learn about the disorder. Additionally, child and adult mental health researchers in Nigeria (Abiodun et al., 2011; Bakare, 2012; Bella, Omigbodun, & Atilola, 2011; Ndukuba, Odinka, Muomah, Obindo, & Omigbodun, 2014; Oshodi, Simoyan, Lesi, & Ibeziako, 2013) share the consensus that the Nigerian teacher training curriculum needs reformation to include, among other topics, information about ADHD. Unfortunately, there is a dearth of information about ADHD in Nigeria (Frank-Briggs, 2011) to inform such education and teacher training curricular reforms.
Although researchers (Adewuya & Famuyiwa, 2007; Bakare, 2012; Bakare, Ubochi, & Ebigbo, 2010; Ofovwe, Ofovwe, & Meyer, 2006; Ndukuba, Odinka, Muomah, Obindo, & Omigbodun, 2014) have established the prevalence of ADHD among
elementary and secondary schoolchildren in Nigeria, no researcher has examined the past and current state of Nigerian general educators’ baseline knowledge about ADHD and their classroom management of inherently negative ADHD behaviors. The prevalence of ADHD and ADHD misperceptions among teachers in Nigeria highlight the need for educational interventions targeted toward improving teachers’ knowledge of ADHD (Adeosun et al., 2013). With improved knowledge about ADHD, Nigerian general educators would be more likely to provide assistive and useful information toward the resolution of ADHD issues within the Nigerian context in order to ensure student success.
Taken together, Nigerian teachers’ level of knowledge about ADHD and
proficiency with behavioral management in the classroom are unknown in the literature (Adewuya & Famuyiwa, 2007). Therefore, additional research is needed to identify Nigerian teachers’ knowledge about ADHD; demographic characteristics, including years
of experience dealing with students who exhibit ADHD behavioral characteristics; and the levels of education, to determine how these factors affect Nigerian teachers’ choices of classroom management strategies.
Extensive research about ADHD currently exists. A majority of the research focuses on the developed world, including North America and some European countries (Adewuya & Famuyiwa, 2007). The external validity and utility of such research may be limited by cultural differences. While various studies have been conducted in countries other than Nigeria to demonstrate teachers’ misconceptions about ADHD, level of knowledge about ADHD, and how to improve teachers’ knowledge of the disorder and students’ academic outcomes (Aguiar et al., 2012; Causton-Theoharis, 2009; Dupaul et al., 2006; Graham-Day, Gardner, & Hsin, 2014; Kozik, Cooney, Vinciguerra, Gradel, & Black, 2009), little is known about Nigerian teachers in this regard.
Purpose of the Study
The purpose of this quantitative, correlational study was to assess Nigerian educators’ knowledge about ADHD and the nature of classroom management strategies they employ for the management of ADHD students. In Nigeria, there is limited or insufficient formal ADHD training for teachers. The body of literature has demonstrated that most researchers who have investigated child and adult mental health in Nigeria, including ADHD and other neurodevelopmental disorders, have advocated the development of training for mental health personnel and teachers, as well as the
incorporation of research outcomes into the teacher training curriculum (Abiodun et al., 2011; Bakare, 2012; Bella, Omigbodun, & Atilola, 2011; Ndukuba, Odinka, Muomah, Obindo, & Omigbodun, 2014; Oshodi, Simoyan, Lesi, & Ibeziako, 2013). Nigerian
teachers have reported common encounters with children with ADHD in their classrooms and the desire to have more training in areas that include knowledge about ADHD and appropriate classroom management of ADHD-related behaviors (Jones & Chronis-Tuscano, 2008; Koutrouba, 2013; Westling, 2010). Thus, uncovering teachers’ knowledge and training will enable the development of appropriate classroom management practices for students diagnosed with ADHD.
Research Questions and Hypotheses
I assessed Nigerian teachers’ knowledge about ADHD and teachers’ classroom behavioral management strategies in a Nigerian school setting pertaining to the following research questions:
Research Question 1
What is Nigerian teachers’ knowledge about ADHD (general awareness, etiology, intervention, and overall)?
Research Question 2
Do Nigerian teachers’ years of teaching experience significantly predict their knowledge of ADHD?
H01: Nigerian teachers’ years of teaching experience do not significantly predict
their knowledge about ADHD.
HA1: Nigerian teachers’ years of teaching experience significantly predict their
knowledge about ADHD. Research Question 3
Does Nigerian teachers’ level of education significantly predict their knowledge of ADHD?
H02: Nigerian teachers’ level of education does not significantly predict their
knowledge about ADHD.
HA2: Nigerian teachers’ level of education significantly predicts their knowledge
about ADHD.
Research Question 4
Does Nigerian general educators’ knowledge about ADHD significantly predict their choice of classroom behavior intervention (academic, consequent, antecedent) for inattentiveness, wandering, poor peer interaction, and speaking out of turn?
H03: Nigerian general educators’ knowledge about ADHD does not significantly
predict their choice of classroom behavior intervention regarding inattentiveness (Vignette 1).
HA3: Nigerian general educators’ knowledge about ADHD significantly predicts
their choice of classroom behavior intervention regarding inattentiveness (Vignette 1).
H04: Nigerian general educators’ knowledge about ADHD does not significantly
predict their choice of classroom behavior intervention regarding wandering (Vignette 2).
HA4: Nigerian general educators’ knowledge about ADHD significantly predicts
their choice of classroom behavior intervention regarding wandering (Vignette 2).
H05: Nigerian general educators’ knowledge about ADHD does not significantly
predict their choice of classroom behavior intervention regarding poor peer interaction (Vignette 3).
HA5: Nigerian general educators’ knowledge about ADHD significantly predicts
their choice of classroom behavior intervention regarding poor peer interaction (Vignette 3).
H06: Nigerian general educators’ knowledge about ADHD does not significantly
predict their choice of classroom behavior intervention regarding speaking out of turn (Vignette 4).
HA6: Nigerian general educators’ knowledge about ADHD significantly predicts
their choice of classroom behavior intervention regarding speaking out of turn (Vignette 4)
Theoretical Framework Theory of Cultural Relativism
The theoretical framework for the study was based on Tennekes’s (1971, as cited in Bothamley, 1993) cultural relativism theory. The assumptions of cultural relativism theory are based on culture-bound perceptions relating to culturally held ideologies, beliefs, values, and norms. Cultural relativism theory portends that these assumptions configure the cultural behaviors, attitudes, views, way of life, and existential experiences of the native citizens of the culture (Herskovits, 1973).
According to Tennekes (1971), cultural relativism theory suggests that each culture or ethnic group has its own values, shared ideals, and beliefs through which the group organizes its collective life, goal, attitude, and worldview, and therefore, each culture or group needs to be evaluated or understood on its own culture-specific terms. Tennekes also suggested that within a culture, a person’s or group’s attitude or perception may change because of certain factors, including the introduction of new information (Tennekes, 1971, as cited in Bothamley, 1993). In this sense, the introduction of new information includes Nigerian teachers’ demographic characteristics: level of education
and years of professional in-service experience or classroom contact with children with ADHD.
The current study assessed what, if any, links exist between Nigerian educators’ attitudes toward ADHD and students’ in-classroom characteristics and the educators’ use of behavioral interventions. Thus, in keeping with cultural relativism theory, a Nigerian cultural perspective will be the best predictor of Nigerian teachers’ knowledge about ADHD and how that knowledge may inform the nature of the pedagogical and classroom management strategies that teachers adopt in inclusive classrooms for students with ADHD. Additionally, the Nigerian cultural perspective in relation to cultural relativism will offer the best delineation of how the educators’ demographic characteristics relate to their knowledge about ADHD.
In Nigeria, inherent cultural beliefs configure attitudes toward and perceptions of disabilities as well as behaviors that are typical of ADHD Nigerian teachers’ associated misconceptions about the behavioral characteristics of ADHD include the notion that these characteristics reflect the influence of malevolent spirits (Ajuwon, Ogbonna, & Umolu, 2014; Tolulope Eni-olorunda, 2008). In Nigeria, children who display characteristics typical of ADHD may be stigmatized, avoided, and perceived as being disturbed by demonic forces (Adeosun, Ogun, Fatiregun, & Adeyemo, 2013; Ajuwon et al., 2014). Nigerian cultural predispositions and negative perceptions of disabilities necessitate an assessment of Nigerian educators’ level of knowledge about ADHD in order to develop psychoeducational interventions targeted toward improving teachers’ knowledge of ADHD (Adeosun et al., 2013) and of instructional practices and behavior management strategies for inclusive classrooms.
Consequently, based on the assumptions of cultural relativism theory relating to Nigeria’s cultural belief system regarding disabilities, this study examined the nature of Nigerian educators’ knowledge about ADHD. In addition, it sought the interaction between the outcomes of Nigerian teachers’ knowledge or quantification of typical behaviors of ADHD and the nature of the classroom behavioral interventions the teachers implemented for ADHD. In addition, it sought to examine the correlation between Nigerian teachers’ demographic characteristics and their knowledge about ADHD. Thus, in collaboration with the intrinsic cultural ideologies, beliefs, and the absence of formal training on ADHD for teachers in Nigeria, indicators of this study validated the
likelihood of the educators’ lack of appropriate knowledge about ADHD and their susceptibility to implementation of more negative and disciplinary consequences for shaping ADHD behaviors in the classroom. Further, the immediate outcomes from this study indicate that Nigerian teachers’ current demographic characteristics may not improve or promote knowledge of ADHD. In addition, the impending outcomes of this study provide indicators that the nature of the Nigerian educators’ choices of classroom management strategies and levels of proficiency are the product of their level of
knowledge about ADHD and culture-driven perceptions regarding the disorder. Consequently, the constructs or indicators of this study remain assistive in locating the specific areas in which Nigerian educators need proficiency and improvement for effective pedagogy and inclusive education.
Nature of the Study
Quantitative (Nonexperimental, Cross-Sectional, and Survey Design)
I employed a quantitative correlational design to respond to the research questions and resolve the problem posed. A quantitative research method engenders postpositivist views with the belief that objective reality controls all social facts and provides
identifiable variables for developing knowledge and measuring relationships (Creswell, 2009). Quantitative researchers state research hypotheses and theoretical assumptions, make inquiries using experiment and survey strategies, collect data on predetermined instruments, and analyze data to confirm assumptions by reducing data to numeric indices to derive deductive logic and inferential statistics (Creswell, 2009; Nastasi & Schensul, 2005). Correlational or predictive designs are appropriate when the researcher desires to measure the strength and direction of a relationship between two or more variables. More specifically, a prediction design measures the predictive effect that one or more independent variables have on a criterion variable (Creswell, 2009).
The current research employed both multiple linear and logistic regression to determine the relationship between the independent variables under consideration— participants’ years of teaching experience and education—and the dependent variables— participants’ self-reported knowledge about ADHD and classroom behavioral
intervention used.
Instrumentation
I used the Knowledge about Attention Deficit Disorder Scale (KADDS) and the Teacher Interventions for ADHD Students (TIAS) survey instruments. Scuitto, Terjesen, and Bender-Frank (2000) developed the KADDS questionnaire. KADDS is a
39-question scale intended to measure the overall knowledge and perceptions teachers have about ADHD. In addition, it consists of three subscales that measure teachers’
knowledge of ADHD in specific areas: general awareness/ symptomatic characteristics, etiology, and intervention.
In addition, Conforti (2012) developed the Teacher Intervention for ADHD Students (TIAS). The TIAS is a 24-item scale addressing antecedent, academic, and consequent strategies that is designed to measure teachers’ perceptions of the
effectiveness of behavior management strategies. It is comprised of four vignettes that demonstrate negative ADHD-characteristic behaviors, including inattentiveness, wandering, poor peer interaction, and speaking out of turn. The items in the TIAS questionnaire scales provide two antecedent, two consequent, and two academic options for modifying negative ADHD behaviors.
Previous researchers employed KADDS and TIAS to assess teachers’ knowledge about ADHD and teachers’ perceptions of the effectiveness of classroom management interventions, respectively. Researchers such as Aguiar et al. (2012); Sciutto, Terjesen, and Bender Frank (2000); and Ohan, Viser, Strain, and Allen (2011) focused on variables related to teachers’ teaching experience and teachers’ highest level of education to assess teachers’ knowledge about ADHD in terms of specific content areas and school-based behavioral interventions. The ADHD content areas include general knowledge/ characteristics, etiology, and intervention, as well as antecedent, consequent, and academic strategies for classroom behavioral management. Consequently, the current study used KADDS and TIAS to assess teacher attitudes and perceptions.
Definition of Terms
The definition of unique words and phrases in the current study promotes full understanding of the problem at hand:
Academic intervention: This is a behavioral management approach employed in an inclusive education environment to reduce negative ADHD behaviors and to promote on-task behavior (Dupaul, Weyandt, & Janusis, 2011). It includes peer tutoring, adapting student curriculum, and modifying pedagogical approach (Dupaul, Weyandt, & Janusis, 2006, 2011).
Antecedent intervention: Antecedent interventions are interventions teachers implement in the classroom to reward positive or target behaviors, and consequently to avert the occurrence of negative behaviors (Dupaul, Weyandt, & Janusis, 2006, 2011).
Consequent strategy: Consequent strategies are interventions executed subsequent to a target behavior to reduce the probability of the behavior’s reoccurrence. Consequent strategies include loss of reinforcement, response cost, and verbal reprimand (Dupaul, Weyandt, & Janusis, 2006, 2011).
Cultural relativism: Cultural relativism suggests that each culture has its own values and norms with which it establishes related worldview and understands the world; therefore, each ethnic group need to be understood in its own culture-specific terms.
Disciplinary consequences or measures: Disciplinary consequences or measures are punitive interventions implemented in the classroom to shape negative ADHD behaviors. They include removal, referral, corporal, and manual punishments.
Inclusion: Inclusion refers to the integration of children with disabilities into regular classrooms throughout the duration of a school session.
Individual education plan (IED): Individual education plans are documents specifying the details of a student’s academic goals and accommodation needs based on earlier assessments of the student (Gordon, 2006; Siegel, 2011).
Least restrictive environment (LRE): A least restrictive environment in inclusive classrooms requires that students with disabilities be provided with all ancillary support or aides and services necessary to ensure a level of comfort that parallels that experienced by their nondisabled peers in the classroom.
Assumptions
The assumptions of the current research included the following:
1. General educators have ADHD students in their classrooms and are familiar with in-class behaviors characteristic of students with ADHD.
2. Use of a survey is a passable technique for data collection when scrutinizing knowledge about ADHD and the interventions used to modify negative ADHD behaviors in regular or inclusive classrooms.
3. All of the teachers who participated in this research provided genuine and accurate responses to the survey questionnaires. To ensure genuineness and probity, anonymity and confidentiality were conserved and participants were volunteers who had the capacity to withdraw from the research at will and at any time.
Scope and Delimitations
A delimitation of the study involved collecting data only from general educators in the country of Nigeria. The focus of the study was gaining an understanding of general educators’ knowledge about ADHD and of the in-class interventions general
educators use in shaping negative behaviors associated with ADHD in regular (inclusive) classrooms. Although the participating teachers in this research were taken from
statewide-stratified groups of schools in the southeastern region of Nigeria, significant portions of the research outcomes may not be generalizable to other regions of the country because of cultural differences.
Limitations
The limitations of the study included lack of a reliable measure of participants’ level of motivation to offer honest responses to the questions posed. Participants received no instrumental benefits other than the opportunity to contribute to the body of knowledge in the pedagogical profession. Another limitation related to cultural and ethnic differences between teachers and students, given that this research was conducted in the southeastern region of Nigeria, where cultural perceptions and practices may differ from those inherent in other regions of the country. Lack of cultural sensitivity on the part of teachers may influence how they perceive students’ ADHD-characteristic behaviors and the nature of the interventions they use to shape perceived negative behaviors in the classroom.
Significance of the Study
Teachers are accountable for meeting the educational needs, fostering the social development, and promoting the academic gain of ADHD students in Nigerian integrated and inclusive classrooms (Kunter et al.,; Reyes, Brackett, Rivers, White, & Salovey, 2012). In this study, I carefully assessed Nigerian educators’ general knowledge about ADHD and classroom behavioral management strategies. Also, I examined the
their choices of classroom management responses to the presentations of negative characteristics of ADHD in the classrooms.
The results of this study may inform policy-makers on the need for continuing education, training, and in-service programs to enhance teachers’ knowledge about ADHD and the skills needed for responding effectively to students with ADHD with appropriate behavioral modification strategies. Teacher training may limit the
disruptions that students with ADHD create for peers in the classroom and reduce the incidence of negative reprimands received by students with ADHD due to teacher frustration. The results from this study may guide the development of improved academic curricula for behavioral management that aligns with effective inclusive classroom practices in Nigeria. Similarly, the knowledge and information gathered from this study may promote greater understanding toward the pursuit of positive social change and may inform the implementation of teacher education curriculum and professional development programs addressing ADHD.
Summary
Previous research has indicated that ADHD is prevalent among students in
Nigerian elementary and secondary schools (Adewuya & Famuyiwa, 2007; Bakare, 2012; Bakare, Ubochi, & Ebigbo, 2010; Ofovwe, Ofovwe, & Meyer, 2006). Teachers’
inadequate knowledge about ADHD and lack of training and competence in managing negative and disruptive behaviors of students with ADHD in the classroom can lead to students’ academic underperformance. When teachers lack adequate knowledge about ADHD (Guerra & Brown, 2012; Koutrouba, 2013; Ohan, Visser, Strain, & Allen, 2011; Rodrigo, Perera, Eranga, Williams, & Kuruppuarachchi, 2011; Sciutto, Terjesen, &
Frank, 2000), they are prone to misconceptions and negative perceptions about their ADHD students (Sciutto, Terjesen, & Frank, 2000). These misconceptions can lead to teachers’ use of negative disciplinary consequences. These consequences may then lead to increased frequency and intensity of the maladaptive behaviors (Kaufman & Brigham, 2009), student resistance and disengagement, and truancy and impaired chronic
externalizing behaviors (Sullivan et al., 2014; Zyngier, 2007).
Through this study, I sought to provide information to enhance Nigerian general educators’ pedagogical effectiveness and in-class behavior management of ADHD students. The results of this study may inform policy-makers about the need for
continuing education, training, and in-service programs to enhance teachers’ knowledge of ADHD and skills needed to respond effectively to students with ADHD with
appropriate behavioral modification strategies. Teacher training may limit disruptions in the classroom arising from ADHD. The results from this study may guide the
development of improved academic curriculum on behavior management that aligns with effective inclusive classroom practices in Nigeria. Similarly, the knowledge and
information gathered from this study may promote greater understanding toward the pursuit of positive social change and may inform teacher education curricular and professional development programs related to ADHD.
Chapter 2 includes literature pertaining to the research questions and the variables. The chapter begins with a historical overview and a discussion of current findings.
Chapter 2: Literature Review Introduction
There is a need for educators to understand Nigerian teachers’ choices of classroom management strategies related to their knowledge about ADHD in the inclusive classroom. This study explored current practice and identified areas in which teachers need support through in-service training and development of a more
comprehensive teacher education curriculum. In Nigeria, students with ADHD in inclusive classrooms need help, structure, and management; thus, teachers’ knowledge about ADHD and use of effective intervention strategies for modifying negative
behaviors associated with ADHD are required to enhance and maximize ADHD students’ learning and academic achievement.
The purpose of the current study was to assess Nigerian teachers’ knowledge about ADHD, teaching experience, and levels of education, as well as to determine whether these factors help to determine their choices of classroom behavioral
management strategies in Nigerian school settings. The objective of the study was to examine the following research questions:
1. What is Nigerian teachers’ knowledge about ADHD (including general awareness, etiology, intervention, and overall)?
2. Do Nigerian teachers’ years of teaching experience significantly predict their knowledge of ADHD?
3. Do Nigerian teachers’ levels of education significantly predict their knowledge of ADHD?,
4. Does Nigerian general educators’ knowledge about ADHD significantly predict their choice of classroom behavioral intervention?
The chapter includes a historical examination, discussion of both dissenting and concurring views on inclusive education, the nature of ADHD, a review of recent findings, description of gaps in the literature, teachers’ knowledge about ADHD within the Nigerian cultural environment, behavioral intervention strategies, and the theoretical framework as it relates to the study. Summarily, the chapter provides a valuable review of the literature that is accessible to experts and nonprofessionals alike. Further, the chapter addresses a gap found within the existing body of literature.
Literature Search Strategy
I obtained the literature compiled for this review through comprehensive online library search methods. Among the journal databases searched, those that generated the most applicable results from the last 5 years were Google, EBSCOhost, ProQuest, ERIC, and ProQuest Dissertations. The search included the following keywords: attention-deficit hyperactivity disorder (ADHD), Nigerian inclusive education, inclusive education,
ADHD behavior characteristics, behavior management, Nigerian cultural environment,
Nigerian educational policy, classroom management, special education, and token economy. I accessed a multitude of other databases in the search process as well. Prior to generating the results, the peer-reviewed feature was selected, ensuring that all of the literature generated would fit this designation.
I reviewed current literature containing empirical research in the relevant areas, which appeared in a wide range of publications, such as Journal of Attention Disorders,
Annual Review of Clinical Psychology, Journal of Positive BehaviorInterventions,
Applied Neuropsychology, and Canadian Journal of School Psychology.
Articles were identified through searches conducted through Academic Search Premier, Education Journals, Education Source, Educational Research Complete, and PsycARTICLES, with a preference for peer-reviewed journals. Additionally, once I identified key authors in this way, the corpus of their work was reviewed for other relevant research, and other works cited by those authors were similarly reviewed. Further, I reviewed identified journals, especially in specifically themed issues, for other relevant work.
Emergence of Inclusive Education
The Macpherson Constitution of 1950 granted autonomy to regional houses to formulate laws in education in Nigeria (Oluwadare & Julius, 2011; Oyelere, 2010; Tsafe, 2013). As the leader of the western region, Chief Obafemi Awolowo introduced his concept of a comprehensive education developmental plan and policy. In 1955, Chief Awolowo introduced the Universal Primary Education (UPE) policy (Oluwadare et al., 2011; Oyelere, 2010; Tsafe, 2013). This education system focused on the notion that comprehensive education is the foundation for the achievement and security of future socioeconomic progress, political stability, and human advancement. By the late 1950s, the eastern region under the leadership of Dr. Nnamdi Azikiwe and the Federal Territory adopted the UPE policy (Oluwadare et al., 2011; Oyelere, 2010; Tsafe, 2013).
Subsequently, in 1976, the Federal Government’s National Policy on Education was established. This policy was created to address a disparity in educational
UPE policy (Itedjere, 1997); the policy was implemented to eradicate illiteracy,
superstition, and ignorance while uniting the nation, building self-reliance, and promoting justice and egalitarianism. Additionally, UPE focused on the achievement of a robust and dynamic economy for the nation, the attainment of a democratic society, and the promotion and provision of equal opportunities for all citizens (Itedjere, 1997). The UPE program, however, failed and was abandoned midway. The failure was attributed to several factors, including a sudden growth in population; an exponential increase in school enrollments, which elicited an unexpected demand for new schools; and a
shortage of qualified teachers (Ajuwon, 2008; Aluede, 2006; Okugbe, 2009). Due to the failure to implement the UPE program and the subsequent educational fallout associated with the end of this period of educational reform, the hope of establishing an efficient, all-inclusive system where all were guaranteed the right to a beneficial education was put on hold. This failure set back inclusive education within Nigeria, resulting in a failure to establish educational norms and guidelines for accommodating included students, among other factors.
In 1977, Nigerian policy-makers amended the National Policy on Education to include Section 8 (Federal Ministry of Education, 1977, p. 1). The purpose of Section 8 was to equalize educational opportunities for all children and adults without regard to physical and emotional disabilities, and to address the needs of exceptionally gifted children to encourage their skills and progressive development at their own individual pace. In 1999, as a spiritual successor to UPE, President Obasanjo restructured the National Policy on Education and introduced the Universal Basic Education (UBE) system. The UBE’s main emphases were education for all (Okugbe, 2009; Oluwadare et
al., 2011; Oyelere, 2010; Tsafe, 2013) and the guarantee that Nigerian citizens and school-aged Nigerian children would have access to 9 years of free, formal basic education (UBE, 2006). This was revised to include Section 7—Inclusive Education (National Policy on Education, 2008). The purpose of inclusive education is to integrate children and other youth with special needs into regular schools and classrooms (Ajuwon, 2008; National Policy on Education, 2008). The National Policy on Education mandated all State Universal Basic Education Boards (SUBEB) to ensure that special-needs
children receive nondiscriminatory and equal access to education in the least restrictive environment. The paradigm of inclusive education involves the concept that all children have the right to education without regard to personal disability, ethnicity, religion, language, or gender (National Policy on Education, 2008).
Despite the revisions regarding inclusive education within the Nigerian educational setting, there are still obstacles facing both educators and students; these challenges, as previously outlined, range from setbacks from decades of rapidly growing populations, unchecked growth in school enrollments, and a shortage of qualified
teachers to address the new challenges of implementing inclusive education within the past decades. One of these challenges, for both educators and students alike, in the implementation of inclusive education within the Nigerian education environment is the high prevalence of ADHD among schoolchildren and less appropriate awareness and management of ADHD within the teacher population.
Attention Deficit/Hyperactivity Disorder (ADHD)
Attention-deficit hyperactivity disorder (ADHD) is considered one of the most commonly diagnosed neurodevelopmental and childhood disorders (APA, 2013;
Alloway, Elliot, & Holmes, 2010;). According to the DSM-5 (APA, 2013), the symptomatic nature of ADHD is delimited by importunate and prominent levels of inattention, hyperactivity-impulsivity, or both that contrive impairment in the affected child’s life and level of functioning.
ADHD: Etiology and Prevalence
The causes of ADHD are unknown; however, the body of literature implicates both genetic (Akutagava-Martins, Rohde, & Hutz, 2016; Han et al., 2015; Ilott, Saudino, Wood, & Asherson, 2010; Nikolas & Burt, 2010) and environmental factors, including prenatal alcohol consumption, exposure to alcohol and environmental tobacco smoke (Han et al., 2015), situational events, circumstances, and diet. Inherent in these environmental factors is the elicitation of adverse variables that include toxic stress, physical and sexual abuse, chronic familial violence, neglect, poverty, malnourishment, and natural disaster. These constructs affect neurological development in children in ways that may elicit ADHD behaviors (American Academy of Child and Adolescent Psychiatry [AACAP], 2011; Burke, Hellman, Scott, Weems, & Carrion, 2011; Garner et al., 2012). Similarly, while indicators from a study by Pearce (2015) noted the increased risk of ADHD for children of adverse biological predisposition, including maternal hyperthyroxinemia in pregnancy, researchers Thapar, Cooper, Eyre, and Langley (2013) performed a critical evaluation of ADHD putative genetic and environmental risk factors, connection with ADHD, and the causal or etiological roles of these risk factors for
ADHD conditions. Results from the research suggested that genetic and environmental factors present covariant and interdependent contributions to the etiological risks of ADHD.
Based on a survey, the average prevalence rate of ADHD globally is
approximately 5.0% for children and 2.5% for adults (APA, 2013). ADHD has been identified as a cross-cultural mental health disorder with significant psychiatric comorbidity in which more than 50% of affected children exhibit one or more
characteristics of a psychiatric disorder (APA, 2013; Bauermeister, Canino, Polanczyk, & Rohde, 2010; Thomas, Sanders, Doust, Beller, & Glasziou, 2015), with comorbid
conditions including behavioral, social, or learning disorders (Humphrey, Aguirre, & Lee, 2012; Wheeler, Pumfrey, & Wakefield, 2009).
ADHD conditions are pervasive; approximately 30%-50% of individuals diagnosed with ADHD in childhood continue to manifest the symptomatic behaviors in adulthood (Barbaresi, Weaver, Voigt, Killian, & Katusic, 2015; Gao et al., 2015). Past research has shown that approximately 4.0% of the U.S. adult population, and up to 6.0% of adults in other nations, struggle with inattention, hyperactivity, and impulsiveness— the primary symptoms of ADHD (Wheeler et al., 2009). Alarmingly, the body of
literature also places the rate of ADHD prevalence in the child population at about 3-7% globally and indicates ADHD as the most common psychiatric disorder diagnosis in the child population (APA, 2013; Willcutt, 2012).
According to Barkley and Murphy (2006), researchers have conducted over 2,000 studies since 1979 on the characteristics and behaviors of students exhibiting ADHD characteristics. In addition, Trout et al. (2007) determined that over 80% of students diagnosed with ADHD who exhibit diminished learning skills are an integral part of the general educational primary and secondary learning environment, and between 1 and 3 of such students are located in each classroom (Barkley, 2015). For example, in a study
involving 964 male participants, Alloway et al. (2010) investigated the prevalence of ADHD among the male student population in the mainstream general education system in the United Kingdom. The results of the study presented an 8.0% prevalence rate among boys in the population, of which 5.0% were unremarkable for hyperactive and impulsive conditions. Through this study, Alloway and associates proposed that prescreening children for ADHD offers inherent benefits by enhancing teachers’ preparedness in organizing appropriate classroom behavioral and academic interventions for students. ADHD Prevalence in Nigeria
While information about ADHD in Nigeria remains limited, contrary to the inference that ADHD is a social construct and culturally bound phenomenon
(Bauermeister, Canino, Polanczyk, & Rohde, 2010; Thomas, Sanders, Doust, Beller, & Glasziou, 2015), a seminal work by Ofovwe, Ofovwe, and Meyer (2006) investigated the prevalence of ADHD among elementary school students in Nigeria and found significant prevalence of the disorder in Nigeria. The study included 1,384 elementary-school students between the ages of 6 and 13 taken from six elementary schools in Benin City, Nigeria. Ofovwe et al. used the Disruptive Behavior Disorder (DBD) rating scale, which focuses on assessing the presence and degree of ADHD-related symptoms. The
researchers reported an 8.0% prevalence rate of ADHD among the primary school children in Nigeria (Ofovwe et al., 2006). Other researchers (Bakare, 2012; Bakare, Ubochi, & Ebigbo, 2010) have documented the pervasive nature of ADHD in the region; recently, Chidi, Chidi, Ebele, and Chinyelu (2014) documented comorbidity of ADHD and epilepsy among Nigerian inpatient children at the University of Nigeria Teaching
Hospital Enugu. However, educators’ levels of knowledge about the disorder as well as their competence with behavioral management strategies are unknown in the literature.
Similarly, in an earlier study, Adewuya and Famuyiwa (2007) established ADHD prevalence as a cross-cultural construct and a non-culture-bound phenomenon. In their study involving 1,152 elementary school student participants from 16 elementary schools, the researchers assessed the prevalence of ADHD and comorbid conditions among
Nigerian elementary school students using the Vanderbilt Attention-Deficit Hyperactivity Disorder Parent Rating Scale (VADSPRS). Indicators from the study were comparable to those found by Ofovwe, Ofovwe, and Meyer (2006), whereas the prevalence of ADHD among the Nigerian school-aged children was 8.7%. Additionally, Adewuya and Famuyiwa reported cross-culturally indiscriminate subtypes of ADHD, including inattentiveness, hyperactivity, and impulsiveness, as well as the comorbid susceptibility of characteristic subtypes with other behavior disorders, such as externalizing behaviors; oppositional defiant disorder (ODD), conduct disorder, (CD), and internalizing behaviors; anxiety and depression. According to Adewuya et al. (2007), anxiety and depression may be comorbid with the inattention characteristic of ADHD, while CD and ODD co-occur with the hyperactivity and impulsivity characteristics of ADHD. In addition, ODD has high prevalence among elementary school students in Nigeria (Frank-Briggs, Angela, & Alikor, 2013) at a 1:4 girl-to-boy ratio, thus necessitating adequate knowledge among teachers about the complexities of ADHD and teachers’ competence in managing the disorder in inclusive classrooms.
ADHD: Subtypes and Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013) delineates the diagnostic features of ADHD and the criteria for its
subtypes. The subtypes of ADHD include predominately inattentive type, predominately hyperactive-impulsive type, and combined type. The general criteria for ADHD include the occurrence of some hyperactive-impulsive or inattentive symptoms before age 12 (Criterion B). These symptoms must manifest in more than one setting or environment (Criterion B). Concrete evidence exists that symptoms of ADHD interfere with or reduce developmentally apposite social, academic, or occupational functioning (Criterion D), and that the symptoms do not manifest exclusively during the course of schizophrenia or other psychotic disorders and cannot be better explained by another psychiatric disorder (Criterion E).
According to DSM-5 (APA, 2013), the criteria for presentation of predominantly inattentive type (Criteria A1) require that an individual exhibit the persistence of six of the nine symptoms for at least 6 months, such as failing to pay close attention to details or making careless mistakes at work often. Other signs include the individual having
difficulty focusing on tasks, seeming to ignore commands when spoken to directly, not following instructions, failing to complete duties in the workplace, and having difficulty organizing tasks and activities. Additionally, these signs are coupled with symptoms such as the avoidance of activities that promote cognitive demand and distraction by
extraneous stimuli.
The criteria for the hyperactive-impulsive type (Criteria A2) are met when the persistent occurrence of six of the nine symptoms is noted in an individual for at least 6
months. These symptoms include the individual often expressing the inability to sit still. In addition, the individual expresses impatience and excessive talking, has difficulty waiting for his or her turn, and interrupts or intrudes on others. Summarily, regardless of the criteria, the associated behaviors of ADHD can create distractions, particularly within the educational setting.
ADHD and Pedagogical Environment
Researchers confirmed that children exhibiting behavioral characteristics associated with ADHD lacked attentiveness, impulse control, self-regulation of activity intensity, and organizational skills (Avisar & Shalev, 2011; DuPaul, & Stoner, 2014; Humphrey, 2009; Imeraj et al., 2013). For example, in a study that examined executive function (EF) in 202 school aged children with clinically diagnosed ADHD and/or DBD (disruptive behavior disorder), Schoemaker, Bunte, Wiebe, Espy, Dekovic´, & Matthys (2012) found association between deficit executive function, impaired inhibition, and ADHD condition. In addition, previous research has shown that these qualities have adverse effects on the presenting student’s social functioning, ability to concentrate on schoolwork and lessons, thus limiting the students’ academic success potentials and can lead to in-class problems (Barkley, 2015; Bruin, Bogels, Formsma, & Weijer-Bergsma, 2012).
Clearly, ADHD symptoms contrive significant adversities in academic functioning of the affected individuals, including inability to complete schoolwork, changing school, school suspension, and expulsion (Martin, 2014); as well, the symptoms present management challenges in the classrooms. According to Silva, Colvin, Glauert, Stanley, Srinivasjois, and Bower (2015), children with ADHD, regardless of gender
